Hufner Tobias M, Brandes Dirk B, Thermann Hajo, Richter Martinus, Knobloch Karsten, Krettek Christian
Department of Trauma, Hannover Medical School, Hannover, Lower Saxony 30625, Germany.
Foot Ankle Int. 2006 Mar;27(3):167-71. doi: 10.1177/107110070602700302.
Nonoperative treatment of complete Achilles tendon ruptures generally involves a long period of cast immobilization and is associated with frequent reruptures. Functional nonoperative treatment of complete Achilles tendon ruptures involves the use of a high-shaft boot with a 3-cm hindfoot elevation, in which physical therapy is begun after 3 weeks of wear. We reviewed our long-term results with this treatment protocol to determine its effectiveness.
The indications for nonoperative treatment, defined by ultrasound, were a distance of 10 mm or less between the tendon ends with the ankle in neutral position and complete apposition of the tendon ends in 20 degrees of plantarflexion. From 1990 to 1996, 168 patients were treated; 125 (74%) were available for followup at a mean of 5.5 (2 to 12.7) years after the injury.
Good or excellent results were achieved in 92 (73.5%) with complete rehabilitation and return to sports activity at their pre-injury levels. Satisfactory (9%) and poor results (17.5%) were due to pain in the Achilles tendon region, a lengthened Achilles tendon, markedly reduced strength, or a marked reduction of calf size in 25 patients (76%). Eight patients (6.4%) sustained a rerupture.
Functional nonoperative treatment achieved good results in patients who had precise sonographic evaluation and who were compliant. As a result of our study, we modified our protocol: (1) a repeat ultrasound examination is done by an experienced sonographer 2 to 5 days after the first to confirm the indications for nonoperative treatment, (2) the use of the 3-cm hindfoot elevation is extended from 6 to 8 weeks to provide a longer protection of the tendon, and (3) patients then wear shoes with 1-cm hindfoot elevation for another 3 months.
跟腱完全断裂的非手术治疗通常需要长时间的石膏固定，且再断裂发生率较高。跟腱完全断裂的功能性非手术治疗采用后跟垫高3厘米的高帮靴，穿戴3周后开始物理治疗。我们回顾了采用该治疗方案的长期疗效以确定其有效性。
超声检查确定的非手术治疗指征为踝关节中立位时肌腱断端间距在10毫米或以内，以及踝关节跖屈20度时肌腱断端完全对合。1990年至1996年，共治疗168例患者；其中125例（74%）在受伤后平均5.5年（2至12.7年）接受随访。
92例（73.5%）获得了良好或优异的疗效，完全康复并恢复到伤前的运动水平。25例（76%）因跟腱区域疼痛、跟腱延长、力量显著减弱或小腿围明显减小而疗效为满意（9%）或差（17.5%）。8例（6.4%）发生再断裂。
功能性非手术治疗在接受精确超声评估且依从性好的患者中取得了良好疗效。基于我们的研究，我们对方案进行了修改：（1）由经验丰富的超声检查医师在首次检查后2至5天重复进行超声检查以确认非手术治疗指征；（2）将后跟垫高3厘米的时间从6周延长至8周以提供更长时间的肌腱保护；（3）之后患者再穿后跟垫高1厘米的鞋子3个月。
